Nebraska not alone in struggle to find mental health workers
The Schuyler SunJul 19, 2017
The shortage of mental health staff in
Now, a former prison doctor is sounding an alarm about the struggle the department is having finding psychiatrists.
Without proper medical oversight of treatment of confined patients with mental health disorders, the state of
The doctor worked for the department from 2008 to 2010 as the first psychiatrist in a new mental health unit at the
Since then, there has been high turnover of department psychiatrists, he said. But many of the mental health administrators who were there when he left are gone, and the department recently contacted him to interview for a position as an independent contractor. He went in for two interviews, but decided not to return, he said.
The department's only psychiatrist, Dr.
Rajagopal believes that without a psychiatrist on staff, the department is making compromises in care. For example, he said, prescriptions for the drug Clozaril, taken by several inmates for schizophrenia, should only be written by a psychiatrist, and weekly re-evaluations done by a psychiatrist, because of its severe side effects.
Deol said he knows of no guidelines that require a psychiatrist only to prescribe and monitor patients taking the drug.
Also, Rajagopal said, there are inmates on court-ordered medication injections that require testimony of two psychiatrists to continue the treatments when the medications are given against the will of the inmates. Without court permission, he said, an unwilling patient cannot be given the medication.
Without proper medical management of mentally ill inmates, Rajagopal believes the violence that has been an issue in the past two years - a riot, serious disturbances, killings of inmates, an assault in the community by an escapee and assaults on corrections staff - will get worse.
Deol said there's no correlation between mental health care and violence in the prisons.
But inmates have complained they go long periods of time without needed counseling or group therapy, and it creates stress.
"Dutiful action is urgent and imperative," Rajagopal said.
Proper mental health care is good for the prisons and the communities to which inmates return, according to a 2015 review of
With it, the department has the opportunity to reduce disciplinary infractions and behavioral disruptions, allow for better program participation and reduce the number of crimes committed after an offender is released, Gage's report said.
Prisons in
That's hard not only for inmates, but for the staff, he said.
Two years ago, Gage's report showed that about one-fourth of 4,800 male inmates and half of 430 women in the prisons were on one or more psychotropic medications.
A conservative estimate, he said, is that 3 to 6 percent have a psychotic or schizophrenia disorder and 10 percent have significant depression or bipolar disorder. The remainder have less-severe conditions.
Deol said the department is meeting psychiatric needs with a psychiatric nurse practitioner, who can prescribe medications, the use of a contract staffing agency and tele-psychology services.
The department's behavioral health team is strong, he said, with every facility having two to four licensed psychologists available or managing triage for mentally ill patients.
In addition, two fourth-year psychiatric residents have been moonlighting on weekends at the Diagnostic and Evaluation Center, where the biggest need is, he said. And a third resident is interested in working at the
Deol said the department is working hard to recruit people, and has interviewed at least four psychiatrists in recent months.
Pay is an issue, he said. Across the country, some psychiatrists have asked for as much as
In 2016, the clinical psychiatrist for the
Other states have a variety of ways to staff their Corrections mental health services.
In
"We have not had any lapses in coverage in the past 15 years," McKinnon said. "From time to time we have had mental health therapy vacancies, but are able to work as a team across the state to maintain a high standard of care for our patients."
Psychiatrist
He was recently promoted to health services administrator there, but also continues to work as a psychiatrist for the
"There's just such a dire shortage everywhere," he said. "It's very concerning and difficult."